Provider Demographics
NPI:1083161160
Name:KACHEEZ PHARMACY LLC
Entity Type:Organization
Organization Name:KACHEEZ PHARMACY LLC
Other - Org Name:KACHEEZ PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ONYEKACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAGERUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-296-9345
Mailing Address - Street 1:122 W MOWRY DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5904
Mailing Address - Country:US
Mailing Address - Phone:305-247-6006
Mailing Address - Fax:305-247-6005
Practice Address - Street 1:122 W MOWRY DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5904
Practice Address - Country:US
Practice Address - Phone:305-247-6006
Practice Address - Fax:305-247-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH303443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019429700Medicaid
2164022OtherPK